PBLS Reservation Form

Thank you for being so interested in our project. We all want to ride in clean bike lanes. This project hopes to improve the overall condition of bike lanes in our area.

Please provide the following information to reserve the People-Powered Bike Lane Sweeper, aka PBLS. Once confirmed, you will receive additional information regarding your reservation and the use of the PBLS.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Cell Phone Number*

Area CodePhone Number

I agree to receive text messages sent by PBLS to the cell phone number entered above.*

YesNo - Please use email

E-mail*

Reference: Please enter the name and contact info of another Charlottean that can vouch for you.*

First NameLast Name

Reference Cell Number*

Area CodePhone Number

Reference Email *

example@example.com

Requested Check Out Date & Time*

Date

Hour MinutesAM/PM Option

Requested Check In Date & Time (24 hour limit unless otherwise approved)*

Date

Hour MinutesAM/PM Option

Have you used the sweeper before?*

YesNo

We provide you a bicycle for you to ride while you sweep. Thank you Trips For Kids Charlotte and the Charlotte Recyclery. However, if you prefer, you can ride your own bicycle.*

I will use the provided bicycle. (Recommended) I understand that the bicycle provided is best fit for people up to 6'2" tall.I will ride my own bicycle. I understand this may require the installation and temporary use of a hitch mount commonly used with bicycles.

Please check to agree. If my reservation is approved I agree to:*

Wear an approved bicycle helmet at all times when operating the PBLS.Never leave the PBLS unattended or unlocked. (lock provided with reservation)Read the "Use and Safety Guidelines" information that will be provided to me once my reservation is approved.Follow all applicable traffic laws as they apply to cyclists.Pickup, use, and return the sweeper within the reservation time frame.

How did you hear about the PBLS Project?

WeeklyRides.comSocial Media Posts and/or EventsFrom A FriendOther

What bike lanes are you hoping to clean? Please be specific to help us keep track and prioritize the streets we are making cleaner and safer.

Thank you for sharing your information. We will review your reservation details. Once approved, you will receive a follow-up email regarding the next steps.

You will be redirected back to our webpage after submitting your information.

Are you participating in the Bike Charlotte PBLS Mileage Monarch Contest?

YesNo

Bike Charlotte is a celebration of all things cycling in Charlotte during National Bike Month. More information regarding the PBLS Bike Charlotte contest is available HERE.

Are You A Hero?*

Yes